BackgroundAlthough most people are aware that tobacco is a powerfullyaddictive and deadly substance, many underestimate the cost ofthe tobacco epidemic in America both socially and economically.

Tobacco kills more than 430,000 Americans each year in theUnited States. Here in Illinois, many of our family and friendsfeel the impact of the 19,000 Illinois deaths each year as a result oftobacco-related illnesses.

The fact that tobacco kills so many isn’t surprising – taking intoaccount that tobacco is the second most heavily advertised prod-uct in the country with companies spending $8.2 billion annuallyto market their products. In Illinois, it is estimated that tobaccocompanies spend $284 million dollars each year on advertising.Most of that advertising is aimed at teens.

Studies show that this advertising is working. Not only do nearly35 percent of high school students use tobacco, but research sug-gests that one-third of underage tobacco use is directly attributa-ble to tobacco company advertising.

In an effort to take a stand, 46 states, including Illinois, sued thetobacco manufacturers in 1998 over their deceptive marketingand advertising practices geared toward teenagers. Under theterms of this agreement, called the Master Settlement Agreement,Illinois will receive $9.1 billion over 25 years. That averages outto between $298.4 and $391 million each year. Illinois legislatorsgave the Illinois Department of Public Health (IDPH) $3.85 mil-lion this year to help develop and execute a youth-focused anti-tobacco campaign.

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I Decide to listen to myself.I Decide my path in life.

I Decide to reach my goals by not smoking.

I Decide not to waste my money.

Illinois Department of

Public HealthThe First Year

2000-2001

I Decide for my family, my friends and people that care about me.

I Decide for my health not to use tobacco.I Decide it’s my life.

Greetings:

I commend the Illinois Department of Public Health’s efforts this past year to col-laborate with local public and private entities to introduce this innovative smokingprevention program targeting Illinois teens. The "I Decide" campaign is off to astrong start and is already showing signs of achieving its goals – to convinceIllinois teens to not start smoking or, if they do smoke, to quit. The campaign’semphasis on choice, which mirrors similar programs in California and Florida, iskey to successfully lowering the number of teens who smoke. Because of theseproven results, the U.S. Centers for Disease Control and Prevention strongly sup-ports states implementing more comprehensive prevention programs like "I Decide."

During the past two fiscal years of my administration, we have allocated approxi-mately $80 million of the state’s share of tobacco settlement proceeds to tobaccoprevention and cessation efforts in Illinois. The "I Decide" initiative is one ofnumerous programs funded through tobacco settlement proceeds in which theDepartment of Public Health is collaborating with other state agencies, localdepartments of public health, local school districts, and other organizations tosuccessfully reach out to various populations throughout the state to promotehealthier ways of life.

Although this report focuses on the first steps of this innovative program, it isapparent they have established a strong base for future success. I compliment

the Department of Public Health for its workand look forward to seeing positive results notonly from this project, but from other tobaccoprevention and cessation programs slated for the coming year.

George H. RyanGovernor of Illinois

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BackgroundAlthough most people are aware that tobacco is a powerfullyaddictive and deadly substance, many underestimate both thesocial and economic costs of the tobacco epidemic in America.

Tobacco use kills more than 430,000 Americans each year in theUnited States. Here in Illinois, many families and friends feel theimpact of the 19,000 deaths that occur each year in the state dueto tobacco-related illnesses.

What is most shocking is how much money tobacco companiesput behind their products. Tobacco is the second most heavilyadvertised product in the country. Companies spend $8.24 billiona year nationally to market tobacco products and $284 millionhere in Illinois. Most of that advertising is aimed at teens. Eachyear in Illinois, 60,000 kids (under 18) become new daily smokers.If current trends continue, 260,000 Illinois kids now under 18 will eventually die from smoking.

Studies show that tobacco advertising is working. Not only donearly 35 percent of high school students use tobacco, butresearch suggests that one-third of underage tobacco use is directlyattributable to tobacco company advertising.

In November 1998, the tobacco companies reached an agreementwith the attorneys general of 46 states, including Illinois, settlingthe states’ Medicaid lawsuits to recover tobacco-related diseasetreatment costs. Under the terms of this deal, called the MasterSettlement Agreement, Illinois will receive $9.1 billion over 25 years,which averages out to between $298 and $391 million annually.

Reaching out to TeensIllinois legislators allocated $3.85 million of the state's settlementto the Illinois Department of Public Health (IDPH) in fiscal year 2001 to help develop and execute a youth-focused anti-tobacco campaign.

The campaign has two major goals:. To reduce rates of tobacco use among teens in a one-county pilot program (Winnebago County was selected). To demonstrate that a comprehensive social marketing campaignaimed at lowering teen tobacco use can be successful

ResearchAt the outset of the campaign, IDPH thoroughly reviewed the U.S.Centers for Disease Control and Prevention (CDC) Best Practicesfor Comprehensive Tobacco Control Programs as well as otherstates’ anti-tobacco programs. This research identified the followingcritical success factors:

. Make teens the driving force of the campaign.

. Create a “brand” identity that is hip and popular.

. Make it cool not to smoke.

. Be where they are (e.g., TV, movies, online, concerts,malls and sporting events).

In addition to the literature review, primary research in the formof focus groups and benchmarking quantitative studies were conducted in Winnebago County. The focus groups identifiedcurrent teen behaviors, as well as receptiveness to different messages–solidifying the strategic direction of the program. The quantitative study, using the CDC Youth Tobacco Surveymethodology, provided detailed information on current attitudesand behaviors, as well as a point of comparison for year-end follow-up.

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An initial quantitative study found rates of teen tobacco use inWinnebago County followed national averages with 35 percent of high school and 15 percent of middle school students currentlyusing tobacco. Furthermore, only 32 percent of high school and40 percent of middle school students reported being taught in theirclasses about the dangers of tobacco use. Overall, 30 percent ofstudents indicated that neither parent had discussed the dangersof tobacco use.

These studies demonstrate that knowledge of tobacco’s negativehealth effects were not well established and awareness of tobaccomanufacturers’ manipulative practices is limited. A comprehen-sive program that would incorporate the critical success factorswas needed to reverse this trend. 3

“Ever since I have beeninvolved in I Decide, I feelthat we have helpedteens quit smoking andhelped them realize thatthey are the main onesgetting targeted.”Kelly MorrisonTeen Advisory Panel MemberRESA Middle School, 8th grade

I Decide for my future.

StrategyAs IDPH began to develop its marketing and communicationsstrategy, the CDC guidelines indicated the $3.85 million that had been appropriated was not enough for a comprehensivestatewide effort. Instead IDPH decided it would be best spenton a one-county pilot program. While this may appear to be a large sum of money, it pales in comparison to the $5.5 milliontobacco companies spend in Illinois each week to market their products.

IDPH developed a multi-faceted com-munications program to empowerteenagers to make an informed decision by educating them on thenegative health effects of tobacco useand tobacco companies’ manipulativeadvertising and marketing practices.The campaign used the energy andtactics of a large-scale, mass marketingcampaign and applied them to the one-county youth anti-tobacco move-ment. This strategy differed from traditional public health campaigns.

4 “Their enthusiasm, theircommitment is conta-gious...and that’s what ittakes to make a meaningfulproject…a campaign that’sgoing to make a difference.”J. Maichle BaconPublic Health AdministratorWinnebago County Health Department

I Decide I’m fed up so I’ll fight back.

Teen Advisory PanelKnowing it was critical that local teens are empowered, 16 studentsinitially were enlisted for an advisory panel to lead the campaign.The teens participated as program advisers and as an in-housefocus group for advertising, marketing and public relations.

The panel also helped to plan an anti-tobacco youth summit tokick off the campaign. They led the summit sessions, brainstormedwith teens from around the county and helped to create what isnow the I Decide movement.

Following the summit, the teen panel was expanded to more than 30 members. Teens were recruited from summit attendees’friends and through the schools.

The teen advisory panel has been the driving force behind I Decide.Meeting on a monthly basis, the teens plan and participate in every aspect of the movement, from Web site development toadvertising to special events planning.

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Teen SummitIn October 2000, more than 230 teens from Winnebago Countycame together at the appropriately named Kick Ash Bash:Make Some Noise Youth Summit. During the two-day event,teens were educated by youth advocacy leaders on the deceptivetactics tobacco companies use to target them, learned the compo-nents of an effective countermarketing program and “made somenoise” about fighting tobacco in their community.

In addition to the educational elements, celebrity guests fromMTV’s “The Real World: New Orleans” shared their opinionsabout tobacco use and signed autographs, a band called “Sticks of Thunder” entertained the teens and local community leadersstopped by to show their support. In a survey after the event, the majority of teens thought all aspects of the summit wereeither “Kick Ash” or “Cool,” the two highest ratings. More than90 percent responded favorably to the youth advocacy leaders’presentations.

Out of the event came I Decide, the name selected by teens for the movement.

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The CampaignI Decide is an anti-tobacco campaign developed by teens for teenswith support and guidance from IDPH. Its goal is to empowerteens to educate their peers and the community about the effectsof tobacco use and the manipulative advertising and marketingpractices of the tobacco companies – encouraging others to“decide” not to use tobacco products.

The I Decide teen panel embarked on an extensive effort tointroduce and familiarize the community with the I Decide programand its objectives. Following the teen summit, the panel selected acampaign logo to brand the movement. I Decide developed six

posters, all with unique messages—fiveare health related and one featuresstatements from panel members tellingthe community why they decide to betobacco free. To ensure that the teen-driven focus of the campaign wasprominent, the posters featured teenpanel members and some were distrib-uted to area schools, churches and localbusinesses that teens visit.

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“I like the idea that we reach out to get thecommunity involved

and that it’s us —‘the

teens‘— who are reach-

ing them. Being in I Dopened my eyes to justhow important it is to let people know what’sreally going on.”Jessica PrattTeen Advisory Panel MemberDurand High School, 10th grade

I Decide not to smell like an ashtray.

AdvertisingAll Smoke HighImagine…you walk into what seems like a nor-mal high school; yet, it’s filled with smoke, itsmells, all the students have cigarettes in theirmouths and oxygen tanks are as common asbackpacks. Welcome to All Smoke High!

The I Decide teens developed television andradio ads centered on All Smoke High, a fic-tional high school where everyone is requiredto smoke. The commercials are based on teens’misguided notion that most or all of their peerssmoke. Filmed in Winnebago County withlocal teens as stars and extras, All Smoke Highshows the absurdity of a world where everyonedoes smoke.

The ads reached 90 percent of the population and research showed72 percent of Winnebago County teens were aware of the com-mercials. Two-thirds of teens said the All Smoke High ads deterredthem from using tobacco. One student said the commercials“catch you with humor and then they actually show the long-term effectsof smoking.”

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“Being a part of I Decidehas been a major thingfor me. Because of I Decide, some of myfriends have quit smok-ing and that’s a goodfeeling. The bus wraphas also made me wellknown throughout myschool. That makes me feel important andinvolved.”Arthur SurrattTeen Advisory Panel MemberWest Middle School, 8th grade

I Decide my path in life.

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I Decide Radio Ads“This is El and I’m around town with I Decide….” During thewinter of 2000-2001, this was a familiar sound on the local top 40radio station. The I Decide teens created nine radio ads, featuringthemselves in real life situations they face when making decisionsabout tobacco use. The imaginative, humorous and simultaneouslyhard-hitting spots focused on communicating anti-tobacco messagesto the target audience—teens.

Bus AdsI Decide traveled all over Rockford…literally. In February 2001, I Decide unveiled a series of bus ads featuring area teens, healthmessages and direct quotes from tobacco industry documents.Research found 46 percent of teens were aware of the bus ads.

BillboardsIn May 2001, a series of I Decide billboards appeared in eight locationsaround the county. With the I Decideteens front and center, the billboardshit hard at the fact that teens aren’t letting the tobacco industry get to them or their money. The billboardsreached an estimated 79 percent of the overall population.

“ I want to congratulateyou on your All SmokeHigh commercials. As a vocal music educationmajor, I frequently runinto fellow students whosmoke, and they don’trealize how bad it is notonly for them, but thosearound them. I hope that by hearing that com-mercial, it will make themand others think twiceabout smoking.”Elizabeth NystedtSenior, Illinois State University

Web siteSince launching in December 2000, www.idecide4me.com hasbecome a popular Web site for Winnebago County teens. The I Decide Web site provides the information teens need tomake the right decision about tobaccouse. By visiting idecide4me.com, teenscan join the movement, learn about thetobacco industry’s manipulative tactics and the latest I Decide activities. Teensalso can check out tobacco movements across the country to get new ideas. The site averages 2,400 hits per month.

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“By participation alone, the campaign was a success…Media exposurewas impressive, too. The students helped createradio, television, masstransit and billboardadvertising urging teensnot to smoke. The high-light of the anti-tobaccocampaign was a slickcommercial that aired on network and cable television called ‘All SmokeHigh’…the piece hadHollywood polish.”Rockford Register StarJune 16, 2001

EducationI Decide teens began recruitment efforts by holding membershipdrives and sending out recruitment kits to area teens and educators.The kits include information on the movement, stickers, member-ship cards, a T-shirt and a copy of IDentity, the campaign newslet-ter. The newsletter is published bi-monthly and includes articleswritten by teen panel members. More than 3,000 copies of thenewsletter were distributed in the first year. An educator’s ver-sion of the kit was distributed to more than 60 area schools.

In addition, I Decide visited Winnebago County schools in Mayand June 2001 with interactive school presentations. Conductedby I Decide teen panel members, the presentations educated teenson how and why they are targeted by big tobacco. The 10 teenpresenters went through an intense, one-day training session inpreparation for this program.

The presentation consisted of shocking tobacco-related statistics,video highlights from the youth summit and interactive elementssuch as a pizza demonstration during which the teens added top-pings to a pizza using samples of the more than 4,000 chemicalsfound in cigarettes, such as nail polish remover, moth balls, vine-gar and rat poison.

In less than two months, I Decide presentations reached approximately 1,800 Winnebago County teens.

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I Decide not to waste my money.

AdvocacyTo make some long-lasting changes in the community, I Decidehas contacted local restaurants and parks to ask them to voluntarilygo smoke-free. The teens, in conjunction with the WinnebagoCounty Health Department, promoted the Illinois Smoke-FreeRestaurant Recognition Program by meeting with area restaurantowners and managers. The total number of participating countyrestaurants rose from about a dozen to nearly 70 thanks to theteens’ efforts. The teens also secured the support of RockfordMayor Doug Scott.

I Decide has been working with the Winnebago County ForestPreserve District and the Rockford Park District to identify waysto make the parks healthier for community members. The teensare developing signage for the forest preserve district designatingsmoke-free areas.

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I Decide to listen to myself.

Minority OutreachIn addition to having an ethnically representative teen panel, the program reached out to both the local Hispanic and African-American communities with targeted efforts. I Decide was featured in the local Hispanic newspaper, El Hispano, and wasthe focus of an episode of “La Vida Buena,” a half-hour talkshow for the Hispanic community. Additionally, members ofthe teen panel presented an educational seminar at “Take Chargeof Your Health,” a local minority health fair and painted a multi-cultural mural titled “Dance and Enjoy Life Without Smoking.”

13“I Decide addresses whatsmoking does to the body,and it affects all racial groups. I thought it wasimportant to get out the message to the Spanish-speaking public. The youngpeople did a super job and we received greatresults and feedback from the community.”Gloria Cardenas CudiaPresident, Rockford Public School BoardCo-host, “La Vida Buena”

EventsI Decide teens have been recruiting their peers bringing events to locations frquented by teens and talking to them about themovement. The result has been a dramatic increase in member-ship since October 2000. I Decide’s membership has grown from 16 to more than 1,500.

CherryVale MallIn February and March, I Decide joined forces with the RockfordIceHogs and local radio station WZOK-FM to spread the word about the dangers of tobacco at a recruitment event atCherryVale Mall. At the event, more than 200 teens joined I Decideand pledged to be tobacco-free by signing an I Decide banner.

IceHogsTeaming up with the Rockford IceHogs hockey team gave I Decidethe chance to make an impression in the community. At anIceHogs game in March, I Decide teens participated in the puckdrop, made announcements about the movement and the dangersof tobacco use, and manned a recruitment table.

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I Decide not to waste my money.

Golf & GamesMore than 350 Winnebago County teens came out to Golf &Games in May and June for mini-golf, bumper boats and videogames. Current members and those who signed up on-siteanswered trivia questions posted at each hole and learned thedevastating effects of tobacco.

Memorial Day ParadeStrolling down the streets of Rockford, I Decide teens made somenoise with WZOK-FM at the annual Memorial Day Parade.Lollipops that said “I Decide not to get sucked in” were handedout as part of the campaign’s community outreach. The teensalso were interviewed by WZOK about tobacco use and the I Decide movement. 15

“I Decide has opened myeyes to new information.I Decide has helped me realize that I should try harder to get myfamily and friends to quitsmoking. I am reallyhappy I joined I Decide.”Kathleen KoelblTeen Advisory Panel MemberHononegah High School, 11th grade

ResultsAlthough still in its infancy, I Decide has produced tremendousresults. In less than eight months, the campaign has recruited1,500 Winnebago County teens for the I Decide movement andclose to 500 community supporters of all ages. Fifty-nine percentof students surveyed in grades 8 - 12 know of the movement; 86percent rated I Decide as “excellent” or “good.” The media alsohave supported the movement. I Decide secured 1.5 million printimpressions and 13 television stories.

Since the inception of I Decide, awareness of the dangers oftobacco and the goals and messages of the movement have left afavorable impression among Winnebago County youth, indicatingthat, when it comes to spreading the word on tobacco, I Decideis on the right track. In less than one year -

. Seventy-two percent of students said they are aware of the “All Smoke High” commercials;

. Fifty percent of students reported having seen or heard an anti-tobacco commercial at least once a day; and

. Two-thirds of non-smokers reported that the television commercialsdeter them from using tobacco.

Perhaps one of the most encouraging results of the campaign to-date is that two-thirds of high school smokers have since tried to quit - an increase of 33 percent. Similarly, two-thirds of teen smokers say they want to quit, a 50 percent increase since October 2000.

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I Decide for my future.

"My mind keeps tellingme to take one of thosecigarettes, but I can't do it. I want to fit inwith my friends. Butever since you guyscame to our school I am a whole new person.I've changed. I don'tsmoke...Thank you, I Decide program. Youmade a difference in my life."Winnebago County student

The Road Ahead...I Decide has enjoyed a memorable first year, yet there is stillmore work to be done. The success of the movement inWinnebago County has paved the way for IDPH to extend the I Decide movement into six additional Illinois counties. Throughadditional support and funding from Governor Ryan and Illinoisstate legislators, I Decide will expand into Champaign, Macon,McLean, Peoria, Sangamon and Tazewell counties during the2001-2002 school year.

“I was immediately attracted to the program because youngpeople would be determiningthe messages used to impactother teens. I think some fantastic, powerful ads havebeen created by the teen advisory panel..."Kris CohnWinnebago County Board Chairman

George H. Ryan, Governor . John R. Lumpkin, M.D., Director Printed by Authority of the State of Illinois. P.O.# 600 11/01